Legal and Ethical Issues

In the case of domestic violence, clinicians agree that conducting couples therapy while there is ongoing domestic violence

presents a potential danger to the abused and is unethical.

In military settings, multiple relationships are common and can be a healthy part of communal life. These relationships:

can improve morale, decrease the stigma attached to seeking psychological assistance, and improve access to care.

Which of the following is NOT a possible multiple relationship in a small community?

A therapist isolates him or herself in order to limit the possibility of multiple relationships.

Ignoring talk of sexuality with clients:

can lead to unintended harm and negative outcomes.

Nakita is an African-American mother with four children who has had difficulty finding housing in a safe community. Lisa, her social worker, suspects that racial discrimination is involved and takes Nakita to sites that she has previously screened for availability. In this case, Lisa is acting as an

Advocate

Which of the following is NOT a controversy of boundary issues?

Age, diagnosis, life experiences such as abuse, and culture are key elements of the therapeutic relationship.

Which one of the following is NOT considered a guideline to minimizing the likelihood of sexual transgressions by clinicians?

Avoid terminating the therapeutic relationship, even when sexual feelings obscure objectivity.

Which of the following actions would maximize the risks inherent in dual or multiple relationships?

Becoming romantically involved with the client

In ___________, the Supreme Court considered that the student had been informed of the faculty's dissatisfaction with her clinical performance, and the student knew that unless she made significant improvement in this area, she would be dismissed from the program. The Court held that the decision to dismiss the student from medical school was based on a careful and deliberate evaluation by the faculty, and thus the student's dismissal was not a violation of her constitutional rights.

Board of Curators of the University of Missouri v. Horowitz

In this role, counselors assist clients in recognizing oppressive forces in the community as a source of their problem and teach their clients strategies for developing political power to bring about change in the clients' social and physical environment.

Change Agent

_____________ is/are a diverse pool of human-service workers whose primary duties include serving individuals within the community in a variety of community groups and includes social workers, community organizers and developers, clinical mental health counselors, psychologists, psychiatrists, nurses, counselors, couples and family therapists, artists, activists, clergy persons, human-service workers with varying degrees of education and training, and residents involved in the community.

Community workers

_______________ is at the core of effective therapy; it is the counselor's ethical duty to protect private client communication.

Confidentiality

__________ has become the main practice within the broad field of family therapy, and its efficacy is well established in hundreds of randomized controlled trials.

Couples Therapy

Martina has been working at a crisis intervention center for three years and is starting to have nightmares about her work. Despite having a strong work ethic, she dreads her job because she feels burdened by the lack of power she has in making decisions pertaining to the treatment of her clients. Martina is experiencing:

burn out

Which of the following is NOT an issue that the dynamics of couples therapy often involves?

Education on the best dating habits

Katie has just accepted her first position as a counselor in a community agency. An agency policy requires her to conduct an intake interview with each client, determine a diagnosis, and establish a treatment plan—all in the first session. Once a diagnosis is established, clinicians have a maximum of five more sessions with a given client. What ethical and legal standards are possibly broken?

Ethical and legal standards requiring professionals to carefully assess and accurately diagnose clients before commencing any intervention

____________ is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.

Evidence-based practice

Bonnie became sexually involved with her therapist soon after therapy began. This action was initiated by the therapist who saw Bonnie's provocative behavior as an invitation to become intimate. Which of the following is NOT a possible ongoing consequence for the client being sexually exploited?

Experiencing feelings of freedom and peacefulness

Schools that receive federal funding are generally bound by the provisions of the:

Family Educational Rights and Privacy Act of 1994 (FERPA).

_______________ extends the duty to warn in California to a foreseeable, identifiable person who might be near the intended victim when the threat is carried out and thus might also be in danger.

Hedlund v. Superior Court

Which of the following statements about giving or receiving gifts is FALSE?

It could be more problematic to accept a gift at a later stage of a counseling relationship.

In ___________, a Supreme Court decision ruled that communications between licensed psychotherapists and their clients are privileged and therefore protected from forced disclosure in cases arising under federal law.

Jaffee v. Redmond

Jan, an incest survivor, is covered for six sessions by her insurance. Her counselor is in private practice and knows that Jan needs more sessions. She decides to offer Jan her services pro bono. In making the ethical decision to ensure that her client has equal access to services, the counselor is using the basic moral principal of:

Justice

Privileged communication does NOT apply in cases of:

child abuse and neglect.

____________ can result from unjustified departure from usual practice or from failing to exercise proper care in fulfilling one's responsibilities.

Malpractice, and Professional negligence

_________________ is designed to encourage reporting of any suspected cases of child, elder, or dependent adult abuse; thus, therapists are advised to err on the side of reporting in uncertain circumstances.

Mandatory reporting

Mentors often balance a multiplicity of roles. Which of the following would NOT be considered one of these roles?

Partner

Kelly, a Christian, is the counselor at a public high school. One day, she was walking through the nurse's office and noticed some pamphlets that discussed safe sex and informed on how to use a condom. Appalled by the material, Kelly threw the pamphlets in the trash and replaced them with pamphlets promoting abstinence. Comparing Kelly's situation to the Grossman v. South Shore Public School District court case, what was the decision of the Seventh Circuit Court of Appeals on the therapist's behavior?

Religious beliefs do not trump the policies and requirements of the employing school district. Kelly acted unethically in disregarding the curriculum of the school and advocating her own personal beliefs about abstinence.

Self-care involves

Searching for positive life experiences that lead to zest, peace, excitement, and happiness.

_____________, with regard to family-of-origin issues, is particularly critical for family therapists.

Self-knowledge

The ___________ perspective, when working with marginalized groups in our society, is most enhanced (a) when mental health professionals can understand how individual and systemic worldviews shape clinical practice and (b) when they are equipped with organizational and system knowledge, expertise, and skills.

Social Justice

_______________ was passed by Congress to promote standardization and efficiency in the health care industry and to give patients more rights and control over their health information.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Which of the following topics would NOT be appropriate to discuss during the initial supervisory session?

The supervisor's marital and family issues

Which of the following is NOT a reason clinical supervisors are increasingly vulnerable and at risk for ethical and legal liability?

There are no formal courses a clinician can take to become a clinical supervisor.

The first essential step toward ethical decision making is:

identifying the problem or dilemma

____________ is a basic component of practitioner competence.

Training

____________ were developed for a wide range of psychological disorders. Their success ushered in the movement toward empirically supported treatments and evidence-based practice.

Treatment manuals

The experts who testified at this trial believed the school board failed to provide adequate training for school personnel. Without training, school personnel will most likely underestimate the lethality of suicidal thoughts, statements, and attempts. The conclusion of this expert testimony was that the student would not have committed suicide if the employees had been adequately trained. Persuaded by this input, the court held that the school could be found negligent for failing to notify the decedent's mother. This explains the court decision in which court case?

Wyke v. Polk County School Board

Effective supervisors understand that:

a collaborative supervisory relationship, characterized by a strong working alliance, is a key component of effective supervision.

Referring a client for differing religious beliefs, sexual orientation, or cultural background is called:

a discriminatory referral.

Nonerotic touching between counselor and client should be:

a spontaneous and honest expression of the therapist's feelings.

From an ethical perspective, counselor educators and trainers are expected to present varied theoretical positions. Training programs would do well to offer students:

a variety of therapeutic techniques and strategies that can be applied to a wide range of problems with diverse clients.

Mental health professionals must move forward and beyond the traditional approach of focusing solely on the intrapsychic, accept and recognize the impact of sociopolitical factors on our clients and their families, and determine how our advocacy can effectively address those issues. Part of their ethical and moral obligation is to

advocate with the aim of creating a just society in which all people have equal opportunities and resources to strive toward their personal goals.

It is illegal and unethical for a therapist to disclose confidential information when:

an employer requests disclosure to determine the mental status of an employee without their consent.

Jolene tells her counselor that she is depressed about the break-up of her relationship and "just wishes she could go to sleep and never wake up." In this case, the counselor needs to:

assess if Jolene is suicidal and intervene if necessary.

Supervisor behaviors and attitudes that have the potential to be extremely damaging include all of the following EXCEPT:

availability, accessibility, and being technically competent.

Those who are responsible for educating and training mental health professionals are ethically and professionally obligated to:

balance their roles as advocate and mentor of trainees with their gatekeeping role.

Susan is in a counselor training program and is infatuated with her supervisor. She has indicated that she is interested in pursuing an intimate relationship. In order to provide adequate supervision for Susan, her supervisor would need to:

clearly define and maintain ethical, professional, and social relationship boundaries with Susan.

Empirical research _________the centrality of the therapeutic relationship as a primary factor contributing to psychotherapy outcomes.

consistently supports

Counselors can encourage ethnic minority clients to learn skills they can use to interact successfully with various forces in their community by acting as their

consultant

An ethical issue arises when:

counselors encourage and promote dependence on the part of their clients.

There are three types of ______________: health plans, health care clearinghouses, and health care providers who transmit health information by electronic means.

covered entities

Prevention programs that help people develop a wider range of competencies, such as interpersonal skills training or marriage education, are considered

direct community services.

Even if clients argue that they can do what they want with their own lives, including taking them, therapists with suicidal clients have a legal:

duty to protect.

Tony, a recently relocated Mexican-American man, is seeking help from a Spanish-speaking organization designed to meet the needs of newly arriving legal immigrants. Tony is quite depressed, but reluctant to talk to his counselor about his problems. The counselor refers him to an indigenous resource who is more likely to be trusted by Tony. He was most likely referred to

either religious leaders and institutions, energy healers, or respected community leaders.

The movement toward grounding psychotherapy practice on a scientific foundation led to the concept of:

empirically supported treatments.

Many professionals struggle with the issue of how to work within a system while retaining their dignity, vitality, and convictions. The most important component in any effort to bring about change is to

examine their attitude and focus on the things that can be changed.

Social justice is referred to as a ____________, which entails a paradigm shift beyond the individual and represents a proactive concern with advocacy and social change and focuses on changing systems and policies on multiple levels.

fifth force

If a therapist is secure in his or her own values, then:

he or she will not be threatened by really listening to, and deeply understanding, people who think differently or do not share the same world view.

Olivia, a new supervisor, is creating a template for a supervisory contract she can use with supervisees. In the contract, she should include information related to all of the following EXCEPT:

her personal religious and sexual values.

When a counselor works in a managed care system, client's goals need to be:

highly specific, limited to reduction of problematic symptoms, and often aimed at teaching coping skills.

Many __________ of war struggle to function in society due to immobilizing PTSD symptoms, substance abuse, and low social support.

homeless veterans

The presence of chronic illness or severe psychological depletion that can prevent a professional from being able to deliver effective services and often results in consistently functioning below acceptable practice standards is called:

impairment.

The process of systemic change can be defined as

increasing public awareness, affecting public policy, and influencing legislation.

Obtaining consultation is important because:

it can uncover ideas that you have not considered, and it can also help you gain objectivity.

When a complaint is lodged against a member of a professional organization, the ethics committee:

launches an investigation and deliberates on the case, eventually reaching a disposition.

Therapists have the responsibility to prevent suicide if they can reasonably anticipate it. Once it is determined that a client is at risk for serious harm to self, the professional is:

legally and ethically required to take appropriate action aimed at protecting the person.

Clients can file a legal complaint against a therapist for sexual misconduct by all of the following methods EXCEPT:

lodging a complaint with the AARP.

James and Mary were in counseling for marital problems. The counselor decided to meet each partner in an individual session before meeting them as a couple. James confided that he was HIV positive and was not going to tell his spouse because she would know that he had been unfaithful. The counselor decided to break confidentially after attempts to encourage James to inform his wife of his condition were unsuccessful. The counselor's action

may be considered ethical, but the practitioner could be in violation of a legal standard.

ASGW addresses both ______________ in their guidelines for training group workers and various other guidelines to increase their knowledge and skills in developing competence in addressing both these issues.

multiculturalism and social justice

Ethics codes are _____________ for exercising ethical responsibility.

necessary but not sufficient

The foundation of all ethical practice is promoting the welfare of clients. To overlook the abilities, strengths, and resources within the community is doing a great disservice to the individuals we serve. If we hope to bring about significant changes within individuals and communities, we

need to change the conditions that affect people rather than change the people affected by these conditions.

Counselors who have unresolved personal conflicts:

need to recognize that their problems may interfere with their effectiveness and refrain from activities that would harm a client.

Mary is seeking abortion counseling from a practitioner who has been actively involved in the pro-life movement. The therapist has extreme discomfort with Mary's values and doesn't think he could maintain objectivity. It would be best if he:

not refer Mary, but work within the client's values rather than his own. If he cannot obtain objectivity, he will need supervision to work through his issues. Referring Mary to another therapist for this reason could be determined as abandonment.

Rhonda is a counselor at a drug and alcohol treatment center. She grew up in an alcoholic home and is not fully aware of the "unfinished business" she has with her parents. She is still angry and resents her parents for having to grow up in an alcoholic family system. It is most likely that Rhonda will:

obstruct the progress of her clients as they attempt to move toward recovery.

When a client is unable to afford therapy, it is possible that he or she may:

offer a bartering arrangement or exchanging goods in lieu of a fee.

Changes in mental health care laws and practice have increased the need for:

outreach psychotherapists.

As therapists, we are often in the role of giver. To preserve our vitality, we need to create spaces in which the "giver" can be supported. A necessary form of ongoing self-care to help in this support is:

personal therapy

James is in court facing drug-related charges and his therapist was subpoenaed to testify in court regarding any discriminating evidence concerning the case. His therapist came to court but refused to answer questions regarding the case or produce James' records. The therapist used the following legal concept to protect himself from forced disclosure:

privileged communication and confidenciality

A counselor is likely to adopt stricter social boundaries and will be concerned about polluting the transference relationship if he or she is:

psychoanalytically oriented.

Susan is quite distressed after finding out her husband has been unfaithful. She tells her counselor that she is so angry that she feels like killing him. Upon hearing this, the counselor needs to:

question Susan to determine whether she is serious about doing physical harm to her husband.

Practitioners can help expand their awareness and clarify their values in dealing with the challenges of their work through:

reading and reflecting on the standards.

A __________ application of boundaries can be harmful to clients by creating a sterile relationship that works against establishing a positive therapeutic alliance.

rigid risk-avoidance

When therapists extend the boundaries of their practice, or when they branch out into an area requiring specialty competence, they should:

seek consultation with a competent practitioner.

Practitioners in rural settings often find themselves involved in multiple relationships. Challenges the deal with include all of the following EXCEPT:

spending a minimal amount of time traveling between professional engagements.

A skilled supervisor balances the multiple roles, giving ongoing feedback, positive and corrective, while also supporting:

the development of the supervisee and ensuring that the power differential is clear.

Barriers to dismissing a student who demonstrates dysfunctional interpersonal behavior from a training program include all of the following EXCEPT:

the potential for receiving criticism from other faculty members who were not involved in the trainee's remediation.

To succeed in a malpractice claim, the plaintiff needs to show that a breach of duty did exist in which:

the practitioner failed to foresee the client's intention to commit suicide despite warning signs that the client was decompensating and/or the practitioner failed to provide the appropriate standard of care.

Autonomy refers to:

the promotion of self-determination and the freedom of clients to be self-governing within their social and cultural framework.

The notion that certain actions will inevitably lead to a progressive deterioration of ethical behavior is commonly referred to as:

the slippery slope phenomenon.

It is believed that countertransference involves:

the therapist's total emotional responses to a client including feelings, associations, fantasies, and fleeting images.

According to the American Counseling Association, counselors practice only within the boundaries of their competence, based on:

their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.

Some people are reluctant to engage in family therapy because

they fear they will be the main target of the sessions and will suffer negative consequences from having divulged certain information.

Maria, a Mexican American woman, will live with her parents until she marries. A culturally competent and sensitive counselor will understand that:

this may be a result of gender-role expectations in Maria's family and not enmeshment.

The goal of counseling from a social justice perspective is

to promote the empowerment of people who are marginalized and oppressed in our society.

Robert runs into the office, unprepared and frustrated because he is late for his weekly appointment with his first client of the day. He is consistently late for his appointments. His behavior is:

unprofessional

In an attempt to convince her young client to practice safe sex, Valerie fabricated her own statistics and facts about the hazards of unprotected sex. In this instance, Valerie violated the principle of:

veracity

Leanne began to feel overwhelmed with her job at the counseling center. In addition to her regular duties, she was responsible for supervising all trainees. To manage her time, she spent a disproportionate amount of time with certain trainees and neglected others, assuming they had the skills to fend for themselves. If a client of one of her neglected trainees decided to file a lawsuit, it is likely that Leanne would bear:

vicarious and direct liability.

Counselors can also reach out to the community outside of the counseling setting by

volunteering at nonprofit organizations in their local area.

Competence in working with couples and families only comes with

years of training and supervision.